A Mystery Case of Proptosis, Optic Neuropathy, and Peripheral Neuropathy

A 23 year-old female with proptosis and ophthalmoplegia.Age 7 - headaches and vision loss to count fingers in left eye; Age 13 - diagnosed with multiple sclerosis; Age 22 - diplopia thought to be bilateral INO; identical twin with sequential bilateral optic neuritis at 8 years, diagnosis of multiple sclerosis at 12 years, and repeated exacerbations of gait impairment20/20 OU; left RAPD; 3 mm right proptosis; -3 adduction in right eye; -2 abduction in left eye; -1 elevation deficit bilaterally; one Lisch nodule; one cafe au lait spot less than 2 cm; Optic nerves appeared pale OS > OD.MRINerve fascicles with loss of large and small myelinated nerve fibers; thin myelin sheathes and frequent 'onion-bulb' formations with concentric layers of Schwann cell processe